{"id":16657,"date":"2023-08-19T14:59:59","date_gmt":"2023-08-19T18:59:59","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=16657"},"modified":"2023-08-22T15:31:25","modified_gmt":"2023-08-22T19:31:25","slug":"cost-effectiveness-analysis-of-pharmacogenomics","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/cost-effectiveness-analysis-of-pharmacogenomics\/","title":{"rendered":"Cost-effectiveness analysis of pharmacogenomics (PGx)-based warfarin, apixaban, and rivaroxaban versus standard warfarin for the management of atrial fibrillation in Ontario, Canada"},"content":{"rendered":"<p><strong>Objective<\/strong> \u2014 To assess the cost-effectiveness of pharmacogenomics (PGx)-based warfarin (i.e., warfarin dosing following genetic testing), apixaban, and rivaroxaban oral anticoagulation versus standard warfarin for the treatment of newly diagnosed patients with nonvalvular atrial fibrillation (AF) aged \u2265 65 years.<\/p>\n<p><strong>Methods<\/strong> \u2014 We developed a Markov decision-analytic model to compare costs [2017 Canadian dollars (C$)] and quality-adjusted life years (QALYs) from the Ontario healthcare payer perspective over a life-time horizon. The parameters used in the model were derived from the published literature, the Ontario healthcare administrative database, and expert opinion. To account for the uncertainty of model parameters, we conducted extensive deterministic and probabilistic sensitivity analyses. The results were summarized using incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.<\/p>\n<p><strong>Results<\/strong> \u2014 We found that PGx-based warfarin had an ICER of C$17,584\/QALY compared with standard warfarin, and apixaban had an ICER of C$64,590\/QALY compared with PGx-based warfarin in our base-case analysis. Rivaroxaban was extendedly dominated by PGx-based warfarin and apixaban. The probabilistic sensitivity analysis showed that apixaban, rivaroxaban, PGx-based warfarin, and standard warfarin were cost-effective at some willingness-to-pay (WTP) thresholds. PGx-based warfarin had a higher probability of being cost-effective than apixaban (51.3% versus 14.3%) at a WTP threshold of C$50,000\/QALY. At a WTP threshold of C$100,000\/QALY, apixaban had a higher probability of being cost-effective than PGx-based warfarin (54.6% versus 22.6%).<\/p>\n<p><strong>Conclusion<\/strong> \u2014 We found that PGx-based warfarin for patients with AF is cost-effective at a WTP threshold of C$50,000\/QALY. Apixaban had a higher probability of being cost-effective (&gt; 50%) at a WTP threshold of C$93,000\/QALY.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objective \u2014 To assess the cost-effectiveness of pharmacogenomics (PGx)-based warfarin (i.e., warfarin dosing following genetic testing), apixaban, and rivaroxaban oral anticoagulation versus standard warfarin for the treatment of newly diagnosed patients with nonvalvular atrial fibrillation (AF) aged \u2265 65 years. Methods \u2014 We developed a Markov decision-analytic model to compare costs [2017 Canadian dollars (C$)] [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,56],"migration-helper-qa-sample-set":[],"class_list":["post-16657","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Hafeez A, Cipriano LE, Kim RB, Zaric GS, Schwarz UI, Sarma S. <em>Pharmacoeconomics<\/em>. 2023; Aug 19 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1007\/s40273-023-01309-z","ices_scientist":[1371],"site":[6739],"research_program":[6747],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin 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